International journal of obstetric anesthesia
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialComparison of intermittent epidural bolus, continuous epidural infusion and patient controlled-epidural analgesia during labor.
The aim of the study was to compare efficacy and side-effects produced by three techniques of epidural analgesia during labor: intermittent bolus (1B), continuous epidural infusion (CEI) and patient-controlled epidural analgesia (PCEA). One hundred and fifty parturients allocated randomly to three groups received the same epidural solution of bupivacaine 0.125% with sufentanil 0.5 microg/mL. In the first group (IB: n=50) boluses were administered by the anesthesiologist and titrated to achieve adequate analgesia. ⋯ The other side-effects were equally distributed in the three groups. We concluded that PCEA with bupivacaine and sufentanil is a valuable technique and a good alternative to the IB method. Compared to the CEI technique, PCEA allows a decrease in local anesthetic consumption without impairing the quality of anesthesia.
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Int J Obstet Anesth · Oct 1999
Randomized Controlled Trial Clinical TrialDose response study of subarachnoid diamorphine for analgesia after elective caesarean section.
Subarachnoid diamorphine provides excellent analgesia after elective caesarean section but the optimum dose is still uncertain. We therefore investigated the effects of three regimens of subarachnoid diamorphine. Forty parturients were assigned to one of four groups. ⋯ The mean (SD) dose of PCA morphine used over 24 h was 39.4 (14.7), 25.6 (16.5), 21.6 (15.9) and 3.1 (3.6) mg, and mean time to first use of morphine was 1.6 (0.5), 3.0 (1.4), 3.4 (2.4) and 14.1 (9.4) h, in the 0, 0.1 mg, 0.2 mg and 0.3 mg groups respectively. Side-effects of pruritus, nausea and vomiting were dependent on the dose of spinal diamorphine but did not require treatment in any patients. We conclude that 0.3 mg subarachnoid diamorphine provides significantly better postoperative pain relief than the smaller doses with an acceptable increase in side-effects.
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A primigravida at 41+ weeks gestation presented with spontaneous rupture of membranes. Labour was induced and later an emergency caesarean section was performed for failure to progress. The patient suffered a per-operative uterine tear and post-partum haemorrhage and required postoperative ventilatory support in the intensive care unit. ⋯ The differential diagnosis, diagnostic difficulties, investigations and clinical management of this case are all discussed. An examination of existing literature highlights some of the focal neurological abnormalities that present with eclampsia and the possible need for more sophisticated neuroradiological investigations in these cases. Finally, it is emphasized that anaesthetists and intensivists need to be aware of atypical and delayed presentations of eclampsia.
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Int J Obstet Anesth · Oct 1999
Anaphylaxis during caesarean section in a patient with undiagnosed placenta accreta: it never rains but it pours!
Published guidelines exist for the management and investigation of suspected anaphylactic reactions associated with anaesthesia. We report a woman who had a life-threatening anaphylactic reaction during caesarean section under spinal anaesthesia, complicated by undiagnosed placenta accreta. We discuss the particular problems of the case and the practical difficulties of testing survivors of anaphylaxis: despite following the recommendations, we have been unable to identify the cause.